GW1-2021-02477_Well Construction - GW1_20210901

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water QualityA
WELL CONTRACTOR CERTIFICATION#3073
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1.WELL CONTRACTOR: s, ,-�e� �' g. WATER ZONES(depth):';
k ,,�` To
Rick Cranes p Bottom Top Bottom
Well Contractor(Individual)Name - r 2021 Top Bottom Top Bottom
Crane Bros. Well Drilling �r 2 �� Top Bottom Top Bottom
Well Contractor Company Name tyl}j#
-� r�LF,i;t� Thickness/
-,
248 Crane Circle I%{Cil 7. CASING: Depth Diameter Weight Material
Street Address UVV'" �- TopO Bottom98 Ft. Sdr-21 pvc
Franklin NC 28734 Top Bottom Ft.
City or Town State Zip Code Top Bottom Ft.
828 524-4976
Area code Phone number 8. GROUT: Depth Material Method
2.WELL INFORMATION: Topo Bottom20 Ft.benonite pumped
WELL CONSTRUCTION PERMIT#061621-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(ff applicable) Top Bottom Ft.
SITE WELL ID#(if applicable)659612971 O 9. SCREEN: Depth ,Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply Top Bottom Ft. in. in.
DATE DRILLED 7-28-2021 Top Bottom Ft. in. in.
Ft. in. in.
TIME COMPLETED AM❑ PM leTop Bottom
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
Depth Size Material
CITY: Franklin COUNTYMacon Top Bottom Ft.
Llovd Stewart Lane Top Bottom Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Top Bottom Ft.
TOPOGRAPHIC/LAND SETTING: (check appropriate box)
[]Slope ❑Valley ❑Flat ❑Ridge []Other
11.DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 M^13 0.0420 "DMS OR 3X.XXXXXXXXX DD 0 /98 ;clay
LONGITUDE 83 0"22 51.5700 "DMS OR 7X.XXXXXXXXX DD : 98 /1005 jgranite
Latitude/longitude source: FPS (]topographic map /
(location of well must be shown on a USGS topo map andattached to /
this form if not using GPS) l
5.WELL OWNER /
Lee Bowe /
Owner Name /
Llovd Stewart Lane. /
Street Address /
Franklin NC 28734 /
City or Town State Zip Code /
Area code Phone number
12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:1005
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: 200 FT. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION
(Use"+"if Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
ED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' PR ID
'Top of casing terminated attar below land surface may require 8-23-2021
a variance in accordance with 15A NCAC 2C.0118. &GffATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 5 METHOD OF TESTAir Rick Crane
C DISINFECTION:Type Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center,Raleigh, NC 27699-161,Phone:[phone] Rev.2/09